In March we chatted with Dr. Zoltán Gyulai, our young internist about England, Gazdagrét and FirstMed. He has been with us for a year now working at both our locations as an internist and a GP and has already been doing much to leave his mark with us.
How did you get started on your road to becoming an internist?
It was my secondary school biology classes that made me want to become a doctor. My teacher inspired me, teaching in a way that made it easy understand biology and other science subjects. Before starting university, two friends and I, we were all looking to go to medical school, so studied in a nursing college for a year. This was an excellent choice because in this school theory and practice alternated every 9 weeks giving us excellent hands-on experience before attending university. Within a year I had been accepted into the Medical University of Debrecen.
Since I was living in Budapest at the time, Semmelweis University may have been a more logical choice, but Debrecen was supported by more professionals. Its reputation and the fact that maintained a unified campus, as opposed to Semmelweis where everything is scattered across the city, were the main reasons of my decision to attend. That my brother had already been studying there at the Agriculture University was just a bonus, making train trips between Debrecen and Budapest together on weekends more enjoyable.
With so many fields how did you choose internal medicine?
Internal medicine is a very logical science, it makes you think. You need have to have a more encompassing knowledge of other medical areas as well, which also made it appealing to me since I could learn more of other specialties. I knew this would be my direction even before the university. Following my studies I returned to Budapest for medical residency at Semmelweis, where I spent 2 years in the cardiology department for MAV Hospital. Some changes took place with the hospital so I transferred Nyírő Gyula Hospital’s department of internal medicine, where I was placed into geriatric medicine. It was definitely difficult as a young physician, as there were roughly 40 patients to a doctor, but my superiors thought it was the challenge I needed. I entertained a much different opinion, especially as I did not see any room for professional development there. I decided that maybe it was time to try working abroad and accepted a job offer in England.
Whereabout in England did you work?
My first work came as a ‘locum doctor’, who gets placed to different hospitals on a need basis. It took me nearly six months with the placement agency that I worked through for them to get to know me better. Then I was able to ask them for a more permanent placement finding work at a surgical center. Another six months and I moved again to the larger, London-based Clementine Church Hospital. I was responsible for 120 beds, 8 of which belonged to the intensive therapy department and there were some of gynecology, oncology and other departments. That required a pretty complex knowledge. During one occasion I spent an entire week in the hospital, so I actually lived there. I returned to Budapest every 2 or 3 weeks, to study and work at the 1st Internal Department of Honvéd Hospital, which held 30 beds. I spent 3 years doing this and I loved it.
Tell us about Gazdagrét
After my internist exam I said goodbye to hospital work, very gratifying as I always wanted to be a family practitioner. Within a year I completed my family practice exam and bought a practice in Gazdagrét (Southern Buda). There are 4 of us, doctors, catering for the 10 000 people who live in the neighborhood. 1750 of them belong to me, to whom I serve 4 hours a day, every weekday in my office, or I do home visits for more serious cases. Fortunately my practice is a well-trained group of people, who only call me on me for home visits when it is really necessary. I feel good in Gazdagrét, as I can be the king of my castle.
It looks like you are an active member of the Hungarian health care system. How does it look to you from the inside?
The national healthcare system is a complex question. Professionally it is of a high medical standard, unfortunately not so high when it comes to its compassion. Many times empathy and compassion are what is missing from this system, caused by staff’ exhaustion, too much overtimes, and a culture of indifference. The result is patients are treated in standoffish, or an aggressive, manner leading them to feel frustrated and timid. There was a day in my practice when we opened 98 charts over 4 hours. Though I did not see all of them in person, even a conversation on the phone takes much mental energy, especially if you want to treat everyone with patience, empathy, and understanding. Patients want you to seem as if their problem is just as important to you as it is for them. Fortunately at FirstMed we are often allotted 30 minutes per appointment, affording us the time to chat, hearing the background stories that are often an important to discovering what is going on with the patient. Of course even a good conversation can be therapeutic for some patients.
Do you have any ideas on how to reform the system?
There is a fundamental weakness in the system which comes from the overall organization. The ‘pavilion- style’ state hospital, where patients must walk outside from one department to another, rain or shine, on huge campuses, is very inefficient. These individual buildings are not very well insulated making them very hard to heat in winter. With too many hospitals, some even nearly empty, the cost of heating them, as well as the other utilities, is counterproductive to the bottom line. This massive waste could be used for so many other useful things. I would subdivide the land, sell the majority of it for development, and put up a modern multi-story hospital on the remaining land, where everything is under one roof.
Though unpopular with the older patients, I would also bring back the visit fee. When the fee was mandatory parasolvency (a kind of mandatory gratuity, or tip, paid to the doctor for service) was far less and there were fewer people in the waiting rooms. Although the fee was set to a low level it still managed to keep a lot the hypochondriacs and lonely at home. Now that it is back to being free, there are people who I see 2-3 times a week, just because they are bored at home and want someone to speak with.
How did you find FirstMed?
A friend of mine, Dr. Ákos Csekeő (also working at FirstMed) suggested it to me year ago. At the time Firstmed was looking for internist to fill up slots at their new district II Hűvösvölgy clinic, so I came at the right time. Since starting there I have also expanded my time working at both locations as an internist.
I like working at FirstMed, because here we have time to deal with patients’ soul, not only their body.
For many, working as a doctor means coming into a clinic or practice, empathetically listening to patients, helping them find solutions to their medical issues, then returning to do it the next day. I think this is a baseline for what it means to be a doctor. At FirstMed we are lucky as all of our staff perform up to this standard every day and for many of them they are able to provide that ‘extra’ something that really make working with them a pleasure.
It was not long after Dr Gyulai joined our staff that he was already offering suggestion on how we could improve our operations, or would enthusiastically provide support to new projects. We at FirstMed really appreciate all the hard work and dedication that all of our staff show our patients as they do this every day. Dr. Gyulai is just another part of what make working at FirstMed a great experience.